Coexisting conditions do not explain racial differences in surgery for non-small-cell lung cancer among U.S. veterans
Black veterans were 37 percent less likely to have surgery for non-small-cell lung cancer (NSCLC) than white veterans, reveals a new study. Differences in number of coexisting medical conditions that may affect surgery decisions did not explain this disparity. Other studies have also found that blacks with early-stage NSCLC were less likely than whites to be evaluated by a surgeon, to have surgery recommended, and to undergo surgery.
Because the Veterans Administration (VA) is a health system expected to have minimal disparities in lung cancer treatment, the researchers examined the effect of racial differences in comorbidities on disparities in surgical treatment for lung cancer for patients diagnosed between October 2006 and December 2007. The findings were based on analysis of data from the VA External Peer Review Program Lung Cancer Special Study. The 1,314 patients included 179 blacks and 1,135 whites.
The prevalence of most individual coexisting conditions was similar among black and white patients. A smaller percentage of blacks had respiratory disease compared to whites, but more blacks had hypertension, liver disease, kidney disease, and illicit drug abuse. However, no racial difference was observed in overall comorbidity.
The association between most coexisting conditions and receipt of surgery did not differ by race, but the authors noted racial variation in surgery according to levels of comorbidity severity. For patients with severe comorbidities, 56 percent of blacks and 45 percent of whites did not have surgery. Also, for each comorbidity level blacks were more likely than whites to refuse surgery. The study was funded in part by AHRQ (T32 HS00079).
More details are in "Influence of comorbidity on racial differences in receipt of surgery among U.S. veterans with early stage non-small-cell lung cancer," by Christina D. Williams, Ph.D., Karen M. Stechuchak, M.S., Leah L. Zullig, Ph.D., M.P.H., and others in the February 2013 Journal of Clinical Oncology 31(4), pp. 475-481.